Healthcare Provider Details

I. General information

NPI: 1508792953
Provider Name (Legal Business Name): VANESSA NAGIN RDMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 ANTHEA ST
SACRAMENTO CA
95834-1062
US

IV. Provider business mailing address

3636 ANTHEA ST
SACRAMENTO CA
95834-1062
US

V. Phone/Fax

Practice location:
  • Phone: 279-218-8459
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number324560
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: